What symptomatic presentations would you expect from a PT with an AA subluxation? Would a pt be able to present with isolated neurological presentations in either the LE or UE? Explain Dermatome or Myotome pattern possibilities if any? Most of the things I’ve seen have involved are UE symptoms, perhaps due to nerve root origin.

The atlanto-axial (AA) joint is the joint between first and second cervical vertebra. AA subluxation (or fracture) may be caused by direct trauma (e.g. domestic falls, automobile or car accidents, work accidents etc.) or by bone disorders such as osteoporosis, rheumatoid arthritis or ankylosing spondylitis etc.

A non-displaced fracture or dislocation of the atlanto-axial joint results in severe pain, numbness and weakness in upper extremities. A displaced fracture or dislocation of the Atlanto-axial joint may cause life-threatening complications resulting from severe spinal cord compression which can lead to significant neurological injuries of upper spinal cord and lower medulla oblongata.

The spinal cord at the cervical level carries nerve fibers to the entire body except for the face and skull. Spinal cord injury from AA subluxation could be a partial or complete injury. Partial injury may cause numbness or weakness in the upper extremities. Complete injury of spinal cord may cause quadriplegia.

Dermatomal patterns, if any, aren’t uniform and are related to tingling and numbness in upper extremity, neck and chest wall and bilateral paresthesia in the upper extremities. Myotomal presentations are reflected in a diminished ability to ambulate, weakness of upper and lower extremities, quadriplegia and breathing difficulties.

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